Clinical integration measures

Measure selection criteria

Quality and Care Process

  • Preventive health
    • Tobacco Use Documentation and Plan
    • Blood Pressure Check (Primary Care Only)
    • BMI Documentation and Plan (Primary Care Only)
  • At Risk Population
    • Diabetes optimal care
    • Hypertension optimal care
    • Optimal vascular care
  • Outcome Measures
    • Potentially Preventable Complications

Readmission Measures

  • Process Measures
    • Recommendations to Outpatient Provider documentation completed
    • 0-5 day hospital follow-up
  • Outcome Measures
    • Potentially Preventable Readmissions
    • All Condition 30-day Unplanned Readmissions

Patient and Care Giver Experience

  • MD Communications
  • Overall Provider Rating
  • Willingness to Recommend
  • Access Composite
  • Staff Courtesy/Respect

Care Process (Access)

  • Percent given required same or next day appointments for non-routine or urgent needs
  • Number of attributed patients using the ED or UC during business hours for less urgent needs

Emergency Department Visit Measures

  • ED Visits Actual-to-Expected Ratio at primary care clinic level based on HCC

Integration Measures

  • Percentage of ED visits in network

Specialty Specific Measures

  • ED-High tech imaging rate - LBP
  • ED/Neuro-IV tPA Administration
  • GI-Adenoma Detection Rate (Female)
  • GI-Adenoma Detection Rate (Male)
  • Neurosurgery-ODI Discectomy/Laminectomy
  • Neurosurgery-ODI Lumbar Fusion
  • OBGYN-Primary C-Section Rate
  • Pathology-Frozen Sections Turnaround
  • Rehab-Non-surgical lumbar outcomes: ODI or FOTO
  • Radiology-Mammography Callback Rate
  • Oncology-Total Pathway Adherence